All adolescents should be screened for alcohol, tobacco, and other drug use at every office visit, the American Academy of Pediatrics recommended.

Action Points

Explain that all adolescents should be screened for alcohol, tobacco, and other drug use at every office visit, according to the American Academy of Pediatrics (AAP).

Point out that rather than asking teens, pediatricians are recommended to use a formal, validated screening tool, such as the CRAFFT screen, at routine visits as well as appropriate acute care visits.

All adolescents should be screened for alcohol, tobacco, and other drug use at every office visit, the American Academy of Pediatrics (AAP) recommended.

Rather than just asking teens, pediatricians should use a formal, validated screening tool at routine visits as well as appropriate acute care visits, according to the AAP statement in the November issue of Pediatrics.

Experimentation, though common, must not be "condoned, facilitated, or trivialized by adults including parents, teachers, and healthcare providers," Sharon J.L. Levy, MD, of Children's Hospital Boston, and colleagues wrote.

The federal Substance Abuse and Mental Health Services Administration recommends that universal screening, along with brief intervention or referral, become a part of routine healthcare.

This step makes particular sense in pediatrics, Levy's group argued.

"As a group, adolescents are at the highest risk of experiencing substance use-related acute and chronic health consequences, so they are also the age group likely to derive the most benefit from universal [screening]," they wrote.

At this age, vulnerability to addiction is particularly high, as are risk-taking and injuries related to alcohol, tobacco, and drug use, the AAP statement explained.

If time doesn't allow for a full psychosocial interview about school and home life, depression and other issues, screening only for alcohol use might be reasonable, it suggested.

In those cases, the full screening should be part of a scheduled follow-up appointment soon thereafter, the statement said.

A quick screening tool it noted as validated for adolescents -- the CRAFFT screen -- asks about use of alcohol, marijuana, or anything else to get high over the past 12 months.

If teens answer "no" to these questions, then the provider asks if they have ever placed themselves at risk by being in a car driven by someone who had been using alcohol or drugs.

Any "yes" answer prompts further questions to determine where along the spectrum from experimentation to addiction the teen may be.

Pediatricians can give brief positive feedback for teens who haven't been involved in alcohol or drug use and encourage changes, or refer out for treatment, those who have been.

A confidentiality policy, along with what safety concerns would prompt breaking confidentiality, should be disclosed before screening.

Of note, billing with defined diagnostic codes for substance use could compromise patient confidentiality when the parents receive an explanation of benefits.

Referral to adolescent-specific specialty care is usually needed for those with signs of acute danger or red flags for addiction, the AAP group noted.

But pediatricians should stay involved, managing these patients collaboratively with specialists whenever possible, and scheduling office visits throughout the recovery process, they urged.

That role remains important after treatment as relapse is common and should again prompt referral, they added.

The statement declared that any conflicts of interest have been resolved through a process by the AAP.

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